Chapter 71: Cyclooxygenase Inhibitors Flashcards
NSAIDs are used to treat what conditions?
rheumatoid arthritis, inflammatory disorders, osteoarthritis, and bursitis. They alleviate mild to moderate pain, suppress fever, relieve dysmenorrhea, and suppress inflammation.
Aspirin is what class? what are its uses and adverse effects?
Nonselective inhibitor of cyclooxygenase, irreversible inhibitor of cyclooxygenase (lasts 7 days)
Uses: analgesic, antipyretic, antiinflammatory, suppression of platelet aggregation, dysmenorrhea, cancer prevention, prev. of Alzheimer’s disease.
Adverse effects: GI effects, bleeding, renal impairment., salicylism, Reye’s syndrome, hypersensitivity reaction
Pregnancy risks: premature closure of ductus arteriosus, prolong labor, postpartum hemorrhage.
what renal signs/symptoms would you be alert for?
BUN/creatinine, urine output, fluid overload
What toxicities do NSAIDs have in common? Lab tests? s/s GI bleed?
GI and renal toxicities, cns depression, and metabolic acidosis.
Lab tests: BUN/creatinine, and creatinine clearance tests. GI Bleed S/S: abd. pain, coffee ground emesis, bright red rectal blood, black tarry stools, dysphagia, hematemesis, chest pain, tachycardia, rebound tenderness, guarding
Do NSAIDs have a better effect on certain tissues than others?
Yes, ibuprofen and naproxen are effective for treating dysmenorrhea. Naproxen, ibuprofen, and aspirin are effective for treating pyrexia.
What is unique about aspirin’s mechanism?
It is the only CARDIO protective NSAID, irreversible inhibition of cyclooxygenase. Length of duration depends on how quickly intended tissues synthesize COX 1 and COX 2
How would you advise a patient who takes a full dose aspirin with an upcoming surgery?
Avoid taking NSAIDS for 7 days prior to surgery. (unless very minor surgery) If low dose aspirin, may need to consult with cardiologist.
What is unique about aspirin in regard to peds patients?
Aspirin is contraindicated in peds patients who have confirmed or suspected influenza or chicken pox. The risk is development of Reye’s Syndrome.
Is NSAID use safe in pregnancy?
They are category C of FDA Pregnancy Risk Categories. they should be avoided.
Do some patients have severe reactions to aspirin/ how is this treated?
Yes, Salicylism: syndrome that begins as aspirin levels rise above therapeutic levels. tinnitus, sweating, headache, acid-base disturbance, and dizziness. Treatment: stopping aspirin until symtoms subside.
Hypersensitivity: profuse watery diarrhea, urticaria, bronchospasm, laryngeal edema, and shock. Treatment is Epinephrine.
Reye’s Syndrome: supportive care, IV fluids, ICU monitoring, ICP monitoring, mechanical ventilation
What is Stevens-Johnson Syndrome?
Severe hypersensitivity reaction that causes blistering of skin and mucus membranes may result in scarring blindness, and death: Ibuprofen is associated with this. It may pose a risk for MI and stroke.
When is Ketorolac used? How long can it be used? who needs to be cautious with this drug?
Post op pain control. Should not be taken more than 5 days.
Contraindicated in pts who have current/history of peptic ulcer disease, renal impairment, GI bleeding, or perforation, prolonged bleeding time, pregnant, in labor, prior to surgery, susp/conf intracranial bleeding, prior hypersensitivity history.
What is acetaminophen?
It is a second generation NSAID, except it does not have anti-inflammatory properties. It lacks the ability to inhibit cyclooxygenase in the CNS and periphery. It can only inhibit in the CNS. It is effective for fever and pain.
which organ is toxic in an acetaminophen overdose?
the liver. toxicity results from accumulation of toxic metabolite in minor pathway. Liver tries to clear this, which depletes gluatthione, and stops liver’s ability to detoxify the metabolite.
What is celecoxib?
COX 2 inhibitor. Uses: osteoarthritis, rheumatoid arthritis, acute pain, dysmenorrheas, familial adenomatous polyposis. It inhibits COX 2 enzyme..
Contraindicated: CABG patients and asthmatics, increases risk of stroke and MI. Patients who are in third trimester of pregnancy, have heart disease or renal disease
